Cardiovascular disease the leading cause of death for PsA

By Emily Delzell

People with severe psoriatic arthritis have a much higher risk of developing both metabolic syndrome – a cluster of cardiovascular risk factors including high blood pressure and abdominal obesity—and insulin resistance, which is an early sign of diabetes, according to findings from a recent study.

“Both metabolic syndrome and insulin resistance increase risk for heart attack and stroke, and cardiovascular diseases are the top leading cause of mortality in patients with psoriatic arthritis,” said Dr. Muhammad Haroon, co-author of the study, published in July in The Journal of Rheumatology.

“We believe the chronic inflammation of psoriatic arthritis drives development of these conditions, which our findings show are very common among people with psoriatic arthritis,” he said.

Metabolic syndrome, which causes chronic low-grade inflammation, is diagnosed when people have three of five well-known cardiovascular risk factors: high blood pressure, blood sugar, triglyceride and cholesterol levels, and a waist circumference greater than 40 inches in men and greater than 35 inches women. Insulin resistance occurs when the body produces the hormone insulin, but can’t use it effectively.

The researchers found high rates of metabolic syndrome symptoms among all patients studied: 74 percent had high blood pressure, 56 percent had an elevated waist circumference, and 43.5 percent had high triglycerides. In addition, doctors diagnosed half the patients with four or more symptoms of metabolic syndrome.

Researchers found that people who developed psoriasis and psoriatic arthritis later in life and those who progressed from skin involvement to psoriatic arthritis more quickly had higher rates of metabolic syndrome and insulin resistance, as did smokers and those with more severe psoriatic arthritis.

All patients were newly diagnosed with metabolic syndrome and insulin resistance. Haroon noted that while screening for these conditions among people with psoriasis and psoriatic arthritis should be part of routine health care, most primary care, dermatology and rheumatology practices aren’t doing that.

People with psoriasis and psoriatic arthritis should ask their doctors about risks and request screening, Haroon said. “Patient education is vital and may be the most fruitful tool in assessing and managing cardiovascular risks.”

Treating metabolic syndrome and insulin resistance lowers cardiovascular disease risk, and may also reduce psoriatic disease activity, though more research is needed to confirm this and determine which treatments might help, he said.

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